小儿痰饮作喘，实因痰壅气逆，其音如潮。响声如曳踞者，古法主苏葶滚痰丸（方见食积咳嗽）。
〔真按〕此方太猛，慎勿轻试。但用甜葶苈三分，淡海蜇皮三钱，鲜荸荠三枚，生甘草五分，煎好，以枇杷
露、杏仁露各半两冲服。
若停饮喘急不得卧者，古法主苏葶丸（如炒苏子、苦葶苈子各等分，蒸枣肉为丸），淡姜汤下。
〔真按〕停饮喘急，先宜泻饮降逆，此丸临时可服，但须以姜汁和枣肉为丸。放小儿口中，衔化徐徐咽下。
若儿过小，改用炒苏子二分，微炒葶苈一分，枣一枚，生姜一小片，煎服。
小儿暴喘，俗谓之马脾风，因寒邪客于肺俞，寒化为热，闭于肺经，故胸高气促，肺胀喘满，两胁煽动，陷
下作坑，鼻窍煽张，神气闷乱，初起古法主五虎汤（如蜜炒麻黄、炒杏仁、生甘草、石膏、细茶等味）。
〔真按〕小儿胸膈积热，心火凌肺，热痰壅盛，忽然大喘，
为马脾风。盖心为午火，属马，言心脾有风热也。急用黑牵牛（生炒）五分（取头末）、锦庄黄（酒润晒干）、
陈枳壳（麸炒）各一钱，煎好，加生白蜜一汤匙，调匀，徐徐灌之，以气平为度。
《经》曰∶诸逆冲上，皆属于火。诸呕吐酸，皆属于热。又曰∶寒气客于肠胃，厥逆而出。故痛而呕。是
呕吐一证，皆诸逆上冲所致也。如溢乳、 乳、呕哕，皆与呕吐相似，不可概以呕吐治之。惟诸逆上冲，始得谓
之呕吐。
究其诸逆之原因∶
或乳食过多，停滞中脘，致伤胃气，不能健运而上逆也。
或于食时触惊，停积不化，而上逆也。
或痰饮壅盛，阻隔气道为上逆。
或蛔虫扰乱，懊 不安为上逆。
总而言之，上逆之因虽不同，而皆成为呕吐则同也。然其中虚实寒热，当于临证时参合兼见之证，审慎以别
之，因作吐解。
小儿因痰饮引发喘息，确实是因为痰浊壅盛、气机逆乱，其声音如同潮水般汹涌。若呼吸声像拖拽重物般艰难，古法主张使用苏葶滚痰丸（方剂详情见食积咳嗽章节）。
〔陈守真按语〕此方药力过于猛烈，切勿轻易尝试。仅建议使用甜葶苈三分，淡海蜇皮三钱，鲜荸荠三枚，生甘草五分，煎煮好后，加入枇杷露和杏仁露各半两冲服。
如果体内停聚的水饮导致喘息急促、无法平卧，古法主张使用苏葶丸（由炒苏子、苦葶苈子等量组成，用蒸熟的枣肉制成丸剂），用淡姜汤送服。
〔陈守真按语〕对于停饮导致的喘息急促，首先应当泻除水饮、降逆平喘，此丸剂可作为临时服用之策，但必须用姜汁调和枣肉制成丸剂。让小儿含在口中，慢慢融化后咽下。
如果患儿年龄过小，则改用炒苏子二分，微炒的葶苈一分，一枚枣，一小片生姜，煎汤服用。
小儿突发喘息，俗称“马脾风”，这是因为寒邪侵袭肺俞穴，寒邪郁而化热，闭塞于肺经，因此出现胸部高耸、气息短促，肺部胀满喘息，两侧胁部随呼吸煽动起伏，肋间凹陷如坑，鼻孔张扇，神志烦闷混乱。初起时，古法主张使用五虎汤（包含蜜炒麻黄、炒杏仁、生甘草、石膏、细茶等药材）。
〔陈守真按语〕小儿胸膈间积有热邪，心火克制肺金，热痰壅盛，忽然发生大喘，这就是马脾风。因为心属午火，对应生肖为马，所谓“马脾风”是指心脾有风热之邪。急需用黑牵牛（生用与炒用各半）五分（取最细的药末）、锦庄黄（用酒润湿后晒干）、陈枳壳（用麦麸炒制）各一钱，煎煮好后，加入生白蜜一汤匙，搅拌均匀，慢慢灌服，以气息平稳为度。
《黄帝内经》说：各种向上冲逆的症状，都归属于火。各种呕吐酸水，都归属于热。又说：寒气侵入肠胃，导致气机厥逆而上出，所以疼痛并伴随呕吐。因此，呕吐这一证候，都是由各种气机上冲引起的。如溢乳、吐乳、干呕呃逆，都与呕吐相似，不能一概当作呕吐来治疗。只有那些气机上冲的症状，才能称之为呕吐。
探究这些上逆症状的原因：
或者是乳食过多，停滞在中脘部位，损伤了胃气，导致脾胃不能正常运化而上逆。
或者是在进食时受到惊吓，导致食物停积不消化，从而上逆。
或者是痰饮壅盛，阻塞气道导致上逆。
或者是蛔虫扰乱，引起心中烦闷不安导致上逆。
总而言之，虽然上逆的原因各不相同，但最终都表现为呕吐，这是相同的。然而其中涉及的虚、实、寒、热性质，应当在临证时结合其他兼见症状，审慎辨别，因此撰写了这篇关于呕吐的解析。
In infants, wheezing caused by phlegm-fluid retention is indeed due to phlegm turbidity obstructing and qi rebellion, with a sound resembling surging tides. If the respiratory sound resembles dragging heavy objects, ancient methods prescribe Su Ting Gun Tan Wan (see Food Stagnation Cough for formula details).
[Chen Shouzhen's Note] This formula is too potent; do not use it lightly. Instead, use only Tian Ting Li (Lepidii Semen, 甜葶苈) 3 fen, Dan Hai Zhe Pi (Metaplexis Japonicae Pericarpium, 淡海蜇皮) 3 qian, Xian Bi Qi (Dioscorea Hypoglauca Rhizome, 鲜荸荠) 3 pieces, and Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma, 生甘草) 5 fen. After decocting, mix in Pi Pa Lu (Loquat Leaf Syrup, 枇杷露) and Xing Ren Lu (Apricot Kernel Syrup, 杏仁露), half liang each, and take orally.
If retained fluid causes acute wheezing and inability to lie flat, ancient methods prescribe Su Ting Wan (made of equal parts Chao Su Zi (Perilla Fructus, 炒苏子) and Ku Ting Li (Lepidii Semen, 苦葶苈), formed into pills with steamed jujube pulp), taken with Dan Jiang Tang (Light Ginger Decoction, 淡姜汤).
[Chen Shouzhen's Note] For acute wheezing due to retained fluid, one should first purge the fluid and descend rebellious qi. This pill can be used temporarily, but it must be made into pills using ginger juice mixed with jujube pulp. Allow the infant to hold the pill in the mouth, letting it dissolve slowly before swallowing.
If the child is very young, substitute with Chao Su Zi (Perilla Fructus, 炒苏子) 2 fen, Wei Chao Ting Li (Lepidii Semen, 微炒葶苈) 1 fen, one jujube, and a small slice of fresh ginger, decocted and taken orally.
Sudden wheezing in infants is commonly known as Ma Pi Feng (Horse-Spleen Wind, 马脾风). It occurs because cold pathogen invades Fei Shu (BL13, Lung Shu, 肺俞), transforms into heat, and blocks the Lung meridian. Consequently, there is chest elevation, shortness of breath, lung distension and fullness with wheezing, flaring of the costal margins during respiration, intercostal retraction forming pits, nasal flaring, and mental restlessness. At the onset, ancient methods prescribe Wu Hu Tang (Five Tiger Decoction, 五虎汤), containing Mi Chao Ma Huang (Ephedrae Herba, 蜜炒麻黄), Chao Xing Ren (Armeniacae Semen Amarum, 炒杏仁), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma, 生甘草), Shi Gao (Gypsum Fibrosum, 石膏), and Xi Cha (Fine Tea, 细茶).
[Chen Shouzhen's Note] Accumulation of heat in the infant's chest and diaphragm, with Heart fire insulting the Lungs and excessive hot phlegm, leads to sudden severe wheezing, which is Ma Pi Feng. Since the Heart corresponds to Wu Fire and the Horse in the zodiac, "Ma Pi Feng" refers to wind-heat affecting the Heart and Spleen. Urgently use Hei Qian Niu (Pharbitidis Semen, 黑牵牛) (raw and fried equally) 5 fen (take the finest powder), Jin Zhuang Huang (Rhei Radix et Rhizoma, 锦庄黄) (moistened with wine and sun-dried), and Chen Zhi Ke (Aurantii Fructus Immaturus, 陈枳壳) (bran-fried) each 1 qian. After decocting, add 1 tablespoon of raw white honey, mix well, and administer slowly until the breathing stabilizes.
The Classic states: All upward rushing symptoms belong to Fire. All vomiting of acid belongs to Heat. It also states: When cold pathogen lodges in the intestines and stomach, causing jue reversal and upward expulsion, pain and vomiting occur. Therefore, the syndrome of vomiting is all caused by various upward rushing paths. Symptoms such as spitting up milk, vomiting milk, and hiccups are similar to vomiting and should not generally be treated as vomiting. Only those involving upward rushing of qi can be termed vomiting.
Investigating the causes of these upward rushes:
It may be due to excessive milk or food stagnating in the Zhong Wan (CV12, Conception Vessel 12, 中脘), damaging Stomach qi, preventing normal transportation and leading to upward rebellion.
It may be due to being startled during feeding, causing food stagnation and indigestion, leading to upward rebellion.
It may be due to excessive phlegm-fluid blocking the airway, causing upward rebellion.
It may be due to roundworms disturbing the interior, causing inner restlessness and upward rebellion.
In summary, although the causes of upward rebellion differ, they all manifest as vomiting. However, the deficiency, excess, cold, and heat patterns involved must be carefully differentiated based on concurrent symptoms during clinical practice. Thus, this treatise on vomiting is composed.